ABSTRACT
Choose the drug overdose from the list above which is most likely to present with the symptoms/signs listed below:
1 Coma, hypotension, flaccidity 2 Coma, pinpoint pupils, hypoventilation 3 Coma, dilated pupils, hyperreflexia, tachycardia 4 Restlessness, hypertonia, hyperreflexia, pyrexia 5 Tinnitus, overbreathing, pyrexia, sweating, flushing, usually alert
410 ANTIDOTES/OTHER SPECIFIC MEASURES IN THE MANAGEMENT OF POISONING
Match the most appropriate antidote/other specific measure from the above list to treat a clinically significant overdose with the agent listed below:
1 Aspirin 2 Paracetamol 3 Methanol 4 Iron 5 Cyanide
ANSWERS: see pages 182-183
394 a) True Methadone elixir/mixture is the mainstay of many drug b) False addiction clinics. It has a long half-life of 15-55 hours and it c) True is very difficult to administer these oral formulations as an d) True injection. Doctors should report cases of drug misuse to e) True their regional or national drug misuse data base or centre
(see BNF)
395 a) False Initially intravenous heroin produces an intense euphoria b) False for several seconds (often accompanied by nausea/ c) True vomiting). Many chronic users often claim the only effect is d) True remission from abstinence symptoms e) True
396 a) True Withdrawal symptoms generally start at the time the next b) True dose would usually be given and their intensity is related c) True to the usual dose. For heroin, symptoms usually reach a d) True maximum at 36-72 hours and gradually subside over the e) True next 5-10 days. Lofexidine, an α2 antagonist, alleviates
many of the withdrawal symptoms. Loperamide helps reduce the diarrhoea
397 a) True In the UK, in men under 70 years, the ratio of death rate b) True among cigarette smokers to non-smokers is 2:1. To assist c) True smokers to give up, nicotine chewing gum, patches, d) True sublingual tablets and spray are available. Varenicline, a e) True selective nicotine receptor partial agonist, and bupropion,
an antidepressant, have been introduced as adjuncts to smoking cessation. Bupropion is contraindicated in patients with a history of seizures or of eating disorders
398 a) False In addition to pharmacokinetic differences, smokers may b) False exhibit altered pharmacodynamic responses (e.g. smokers c) False show less CNS depression after a standard dose of d) False diazepam than non-smokers) e) True
399 a) True It has been estimated that the incidence of alcoholism in b) True North America and Western Europe is nearly 5 per cent c) True of the population. Ethanol is a weak inducer of its own d) False metabolism but is a more potent inducer of the metabolism e) False of drugs whose principal metabolic process is via CYP450
particularly CYP2E1 and differences in rate of ethanol metabolism are principally genetic
b) – Associated with smoking c) True d) False – Associated with smoking e) False – Associated with smoking
401 a) False – 10 per cent b) True c) False – Clormethiazole and benzodiazepines (long half-life) are
suitable sedatives d) True – To avoid precipitation of acute thiamine deficiency when
intravenous dextrose/oral carbohydrates are administered e) False
402 a) False Anabolic steroids are abused by athletes to build up muscle b) False tissue c) True d) True e) False
403 a) True MDMA is widely abused for its stimulant and hallucinob) True genic properties. It is metabolized by CYP2D6, which it c) True inhibits for up to two weeks following a single dose. It is d) True occasionally associated with hyperpyrexia, hyponatremia, e) True rhabdomyolysis and coma
404 a) False A meticulous, rapid but thorough clinical examination is b) True essential not only to exclude other causes of coma or c) False behaviour, but also because the symptoms and signs may d) True be characteristic of certain poisons (see Table 4) e) False
405 a) True – See Table 5 b) True c) False d) False e) True
406 a) True – See Table 6 b) True c) True d) False e) True
407 a) False Paracetamol and salicylate overdoses only very rarely b) False cause coma acutely. Acetylcysteine is a potentially c) True life-saving antidote in paracetamol overdose d) True e) False
408 a) False The authors recommend champagne! b) False c) False d) False e) False
409 CLINICAL MANIFESTATIONS OF DRUG OVERDOSE
1 E Coma, hypotension and flaccidity are characteristic of a significant benzodiazepine or ethanol overdose (remember to smell the breath).
